Lower Back Pain Management Through a Digital Musculoskeletal Practice Unit: Pain and Functional Outcomes.

BACKGROUND

Leading cause of global disability, lower back pain, affects 84% of adults and costs the U.S. $134 billion annually. Traditional care fails to improve outcomes despite rising spending. This study assessed the effectiveness of a digital musculoskeletal integrated practice unit (IPU) in reducing pain and function in adults with back pain.

METHODS

We conducted a retrospective cohort study of 784 adults (18-95 years) with low back pain enroled in our IPU between September 2023 and February 2025. Intervention included virtual physician/nurse practitioner and physical therapist assessments, coordinated care with health coaching and nutrition counselling, and digital physical therapy. Primary outcomes were improvement in pain (Numeric Pain Rating Scale) and function (Single Assessment Numeric Evaluation). Analyses used paired t-tests for within-subject changes, multivariable linear regression adjusting for baseline severity, follow-up duration, age, sex, and comorbidities, and engagement-stratified analyses to assess associations between visit frequency and outcomes.

RESULTS

Among 784 patients (mean age 60.1 ± 17.0 years), mean pain scores decreased 4.94 ± 0.07 to 2.61 ± 0.08 (p < 0.001, Cohen's d = -1.02), with 61.9% achieving the MCID of ≥ 2-point pain reduction. Among patients with severe baseline pain (≥ 7), 78.1% achieved pain MCID. Among the 688 patients (87.8%) with paired functional data, SANE scores increased 51.18 ± 0.96 to 74.97 ± 0.83 (p < 0.001, Cohen's d = 0.94), with 58.0% achieving SANE MCID of ≥ 15 points.

CONCLUSIONS

Digital musculoskeletal IPU care for low back pain may provide convenient access to care for patients while supporting clinical effectiveness.